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Three Ways Physicians Can Prepare for the Medicaid Influx


The Affordable Care Act’s Medicaid expansion means more patients at your practice. Here’s how to accommodate them.

Physician practices can expect to see a lot more patients in the next few years thanks to the Affordable Care Act (ACA), in particular the ACA’s Medicaid provision and the health insurance mandate.

The Medicaid provision, which it expands coverage to individuals up to 133 percent of the poverty level, or 17 million more Americans, goes into effect in 2014 (one year before the insurance mandate, which was pushed back to 2015). As a condition of expansion, the federal government will pick up all healthcare costs for the first few years and 90 percent of expenses after that.

While the majority of states either have already opted to participate or indicated plans to participate in the Medicaid expansion, as of July 26, 16 states do not plan to participate, according to The Advisory Board Company.

Still, all practices can expect a patient influx, regardless of state Medicaid expansion plans, said Charlie Jarvis, senior vice president of health reform at NextGen Healthcare.

“The predominance of health insurance exchanges is going to bring more patients [to practices], period,” Jarvis told Physicians Practice.

While some physician have indicated plans to close their doors to new Medicaid patients (six percent of the 1,172 physicians who answered according to our Great American Physician survey, Sponsored by Kareo) and others have said they may drop the program altogether (nine percent, according to the survey), many are not. In fact, 56 percent of physicians revealed that they definitely plan to continue to serve Medicaid patients in the foreseeable future. The issue, then, becomes this: When primary-care physicians are in dwindling supply, and the demand for primary-care services increases, how can doctors accommodate an expanded Medicaid patient population?

Here are three ways practices can prepare for the Medicaid patient influx:

1. Get Staff Ready: Make sure practice staff and clinicians are ready to expect a potential surge of new patients - before the surge hits. This might mean, for example, telling front-office staff to expect to spend more time on the phone scheduling appointments, or medical billing staff they will have to become more well-versed with Medicaid plans’ payment rules. “What is really important here is to encourage the staff to be able to address those patients just like they would any other patient that needs to be cared for, and make those patients not feel different,” said Jarvis.

2. Tap into Technology: New technology such as patient portals can make it easier for front-office staff and physicians to send messages to patients, schedule appointments, and collect bill payments. These things can be huge time savers for everyone. However, it’s important that practice staff is mindful that less-financially-affluent patients may not have the means to access portal messages or electronic scheduling requests. “As long as the patients are able to access the scheduling software, then they should be encouraged to do so,” said Jarvis. “Don’t make patients feel inferior if they don’t capability.”

3. Bolster Your Supporting Cast: While the number of primary care physicians is expected to drop, the number of nonphysician providers - such as nurse practitioners and physician assistants - is growing steadily. Boosting the number of midlevel providers at your practice may help you better handle the volume of patients (Jarvis also recommends boosting your billing and administrative staff, if possible). However, Joseph Valenti, a Denton, Texas-based OB/GYN Denton, and board member of The Physicians Foundation, cautions that midlevel providers can only do so much. “As far as more complicated patients, a lot of [Medicaid] patients have complex problems,” Valenti told Physicians Practice. “There’s going to need to be specialists to deal with them.”

What are you doing to prepare your practice for the Medicaid?

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